Germany

End-of-Life Care Neglected in Germany

A raging debate about assisted suicide in Germany has drawn attention to the generally poor care that the terminally ill receive.

Only a minority of the terminally ill are cared for in hospices

Last week, Health Minister Ulla Schmidt pledged 250 million euros ($300 million) to improve and expand hospices and palliative care in the Germany. The latter is loosely defined as a holistic attempt to treat persons suffering from incurable illnesses in such a manner as to relieve their pain as far as possible and provide emotional and spiritual care to improve the quality of their lives so that they can die in dignity. Schmidt has also promised to set up 330 teams of trained palliative care experts across the country.

Many in the health services have welcomed the move.

"Death and dying are still touchy subjects in our society and politicians have only paid lip service until now. But we're glad that they're finally giving in to our long-standing demands for more funds," said Thomas Schindler, head of the Bonn-based German Society for Palliative Medicine. "Though palliative medicine has made progress in Germany, we still have a lot of catching up to do compared to other countries."

The Netherlands allows euthanasia, but there too it has been controversial

Josef Winkler, a Green party parliamentarian and member of the commission on ethics and law in medicine, a body comprising members of parliament and experts that advises the government, agreed. Compared to countries like the Netherlands -- which is often slammed by German anti-euthanasia groups for legalizing the practice -- Germany comes off "extremely badly" when it comes to palliative care and taking care of its dying, Winkler said. He added that the country urgently needed a nationwide palliative care system for the terminally ill.

Hospices beyond the reach of majority

The majority of terminally ill patients die in hospitals and nursing homes, often lonely and in pain. It's estimated that of the 850,000 people dying in Germany each year, only about 2 percent receive end-of-life professional care and just about 1,150 hospice beds are available for them throughout the country.

The issue of caring for the dying has gained attention in recent weeks ever since Dignitas, a Swiss-based organization for assisted suicide, opened a German chapter in Hanover. The group says that more than half of the 453 people they helped to their deaths since 1998 have been Germans who traveled to Switzerland for release from their suffering.

But what can be done to ease the suffering? For starters, experts in the field agree that one of the most pressing problems is insufficient financing of professional end-of-life care at home, which involves a network of voluntary workers and nursing care personnel who are in intensive contact not just with the dying patient at home but also with the family members.

"More money is needed there because the work is so time-consuming and painstaking," said Schindler. "And we need to invest more in training programs, because many doctors only care for the dying on the fringes and are unsure of the right way to go about it."

Training doctors

Future doctors in Germany may well have palliative medicine as a subject

Investing in further training and education programs in palliative care as well as research is also a key demand that the medical ethics commission included in its recent report on the state of palliative care and hospices in Germany. It went a step further by adding that palliative medicine should be a mandatory subject on the curriculum for all prospective doctors.

"It can't be that in a highly-developed country like Germany, doctors are unable to help dying patients because they aren't qualified to do so," said Winkler.

"There's an extremely low number of cases where doctors really can't help a patient anymore, and with the current advances in medicine and palliative care, dying patients do have a chance to live pain-free," he said.

But given the debate on assisted suicide, the immediate goal is to drastically increase the number of well-organized hospices in the country.

"We sometimes have patients who are on our hospice waiting list for as long as three to four weeks," said Johannes Schlachter, head of nursing care at the Ricam hospice in Berlin. "And sometimes it's just too late by then."